PRAIRIE ISLAND INDIAN COMMUNITY (NPI# 1821305129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821305129 |
| Entity Type | Organization |
| Organization Name | PRAIRIE ISLAND INDIAN COMMUNITY |
| Other Organization Name | PRAIRIE ISLAND COMMUNITY CLINIC |
| Practice Address |
1158 Island Blvd Welch MN 55089-9540 |
| Practice Telephone | 6513854148 |
| Practice Fax Number | 6513854170 |
| Mailing Telephone | 6513854148 |
| Mailing Fax Number | 6513854170 |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2010-09-08 |
| Authorized Official Name | VICTORIA WINFREY (TRIBAL COUNCIL PRESIDENT) |
| Authorized Official Telephone | 6513854105 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Prairie Island Community Clinic | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRAIRIE ISLAND INDIAN COMMUNITY | 5636 Sturgeon Lake Rd, Welch, MN 55089-9635 |
| Street Address |
1158 ISLAND BLVD |
| City | WELCH |
| State | MN |
| Zip Code | 55089-9540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558440164 | Michael Cowan | Surgery | 1158 Island Blvd, Welch, MN 55089-9540 | 2006-11-03 |
| 1144784786 | Marla Decker | Nurse Practitioner | 1158 Island Blvd, Welch, MN 55089-9540 | 2019-01-28 |
| 1053810846 | Erica Marie Bohlke | Physician Assistant | 1158 Island Blvd, Welch, MN 55089-9540 | 2018-02-07 |
| 1073050761 | Piic Clinical Services | Clinic/Center | 1158 Island Blvd, Welch, MN 55089-9540 | 2017-01-19 |
| 1881901114 | Bernice Kae Ronningen | Licensed Practical Nurse | 1158 Island Blvd, Welch, MN 55089-9540 | 2010-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568075356 | James Kuhaulua | Massage Therapist | 10 Old Deerfield Rd, Welch, MN 55089-9515 | 2020-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457952814 | Maura Smith | Technician | 82 Little Egypt Rd, Welch, WV 24801-2922 | 2020-11-03 |
| 1144821687 | Amy Marie Dotson | Technician | 124973 Loop Seven Highway, Welch, WV 24801 | 2020-11-02 |
| 1386243947 | Lora Bailey | Technician | Riverside Dr, Welch, WV 24801 | 2020-10-23 |
| 1245839141 | Betty Ann Sprouse | Technician | 160 Grandview St, Welch, WV 24801-2110 | 2020-10-21 |
| 1215543038 | Tymeisha Saunders | Technician | 47 Riverside Dr Apt 14, Welch, WV 24801-2538 | 2020-09-17 |
| 1174138515 | Amy Lee West | Nurse Practitioner | 454 Mcdowell St Ste B, Welch, WV 24801-2029 | 2020-09-12 |
| 1568075356 | James Kuhaulua | Massage Therapist | 10 Old Deerfield Rd, Welch, MN 55089-9515 | 2020-08-31 |
| 1053924142 | Brittany Rotenberry | Technician | 173 Virginia Ave, Welch, WV 24801-2436 | 2020-08-28 |
| 1548873904 | Lora Jane Lambert | Technician | 12 Willis Ways Rd, Welch, WV 24801-9781 | 2020-08-26 |
| 1245842491 | Brittany S Copley | Technician | 299 Beech St, Welch, WV 24801-2307 | 2020-08-19 |
| Find all providers in WELCH | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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|---|---|---|---|---|
| 1871191403 | Cham Clinic LLC | Clinic/Center | 7362 University Ave Ne Ste 206, Fridley, MN 55432-3151 | 2020-10-15 |
| 1003434622 | Lost Lake Optical Company | Clinic/Center | 5240 Shady Island Cir, Mound, MN 55364-9222 | 2020-07-09 |
| 1811513310 | Prescribed By LLC | Clinic/Center | 701 Washington Ave N Ste 111-321, Minneapolis, MN 55401-2822 | 2020-06-19 |
| 1992320014 | Jtp Professional Service Corporation | Clinic/Center | 2038 Ford Pkwy # 444, Saint Paul, MN 55116-1931 | 2020-06-15 |
| 1689299125 | Altru Health System | Clinic/Center | 1st & Roosevelt, Karlstad, MN 56732 | 2020-06-10 |
| 1831710409 | Webmed LLC | Clinic/Center | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-05-05 |
| 1073149779 | Functional Chiropractic Rehab, Pllc | Clinic/Center | 1901 Madison Ave Ste 120, Mankato, MN 56001-6267 | 2020-03-14 |
| 1225676067 | Liana Healthcare P.ll.c | Clinic/Center | 8348 Beard Rd, Bloomington, MN 55431-1028 | 2019-12-11 |
| 1245875293 | Fairview Clinics | Clinic/Center | 12912 Farnham Ave N, White Bear Lake, MN 55110-5929 | 2019-11-14 |
| 1275175242 | Hye-kyong Kim Therapy LLC | Clinic/Center | 1145 Grand Ave # 101, Saint Paul, MN 55105-2629 | 2019-10-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.